糖尿病新生血管性青光眼23G玻璃体视网膜手术

Drainage valve implantation combined with 23G vitreoretinal surgery for diabetic neovascular glaucoma

目的 探讨23G玻璃体视网膜手术治疗糖尿病性新生血管性青光眼的效果。方法 回顾性研究22例（22眼）糖尿病性新生血管性青光眼先作青光眼引流阀植入控制眼压，在1月内作23G玻璃体视网膜手术。术后随访6—12月，观察眼压变化。结果 16例手术后眼压在正常范围，4例需要加用降压药物控制，2例眼压未能控制。视力光感3例，手动2例，数指4例，0．05—0．1者7例，0．12～0．3者4例，0．4以上2例。术后复发性视网膜脱离3例；2例再次出现虹膜新生血管；前房积血7例，1—2周后吸收；取出硅油后再次玻璃体积血2例，行玻璃体腔冲洗及补充激光光凝；视神经萎缩2例；前部葡萄膜炎2例。结论 青光眼引流阀植入和23G玻璃体视网膜手术治疗糖尿病性新生血管性青光眼是一个较有效的治疗方法。

Objective To investigate the efficacy of drainage valve implantation combined with 23G vitreoretinal surgery for diabetic neovascular glaucoma. Methods Twenty-two eyes of twenty-two patients with diabetic neovascular glaucoma underwent 23G microincision vitreoretinal surgery one month after drainage valve implantation. The follow-up ranged from 6 to 12 months. The change of the intraocular pressure （IOP） was observed after operation. Results The IOP of 16 eyes were successfully controlled, 4 eyes were efficiently controlled with anti-glaucoma medicine, and 2 eyes were not controlled. The best corrected visual acuity after surgery was light perception in 3 eyes, handmovement in 2 eyes, counting finger in 4 eyes, 0.05 ~0.1 in 7 eyes, O. 12 ~0.3 in 4 eyes, I〉0.4 in 2 eyes. Among the complications after operation, retinal detachment reappeared in 3 eyes, rubeosis iridis reoccurred in 2 eyes. And hyphema in 7 eyes,which absorbed after 1-2 weeks. The recurred vitreous hemorrhage occurred when the silicon oil was removed in 2 eyes. They were performed vitreous body irrigation and photocoagulation. Optic atrophy was found in 2 eyes, and anterior uveitis in 2 eyes. Conclusion Drainage valve imp!antation combined with ~3G vitreoretinal surgery is considered to be an effective treatment for diabetic n^ovascular glaucoma.